Otoplasty: a guide to ear surgery in adults

Otoplasty, or ear surgery, is the operation that sets prominent ears, so-called bat ears, closer to the head, reduces ears that are too large or improves a shape you are not happy with. It is only considered for adults. On this page we explain what is corrected, how it is done, which technique is chosen and how long recovery takes, so that you go to your first appointment knowing what to ask.

What can be achieved is decided by the surgeon when examining your cartilage.

What is otoplasty?

According to SECPRE, it is the operation that brings prominent ears (so-called bat ears) closer to the head or reduces ears that are too large. They are very common: a 2020 systematic review (Jones and colleagues) describes them as the most common congenital anomaly of the head and neck, present in around 5% of the white population. Why they stick out, the fold and the concha, is covered in the article on sticking-out ears.

Which ears otoplasty can correct

Above all, those that stand out from the head, on one side or both and to very different degrees. Ears that are too large, other less common shapes and previously operated ears that did not turn out as expected are also treated; in that case, bring the report from that operation. Even if only one looks different, SECPRE points out that in most cases both are operated on to achieve better symmetry.

Who is otoplasty considered for at Clínica EGOS?

It is considered for adults, that is, from the age of 18. What is asked is the same as for any planned surgery: good health, not smoking and a clear idea of what you want to change. The decision should be yours, and not a way of pleasing others or of matching someone else's ideal. SECPRE reminds us that the aim is an improvement, not perfection: you should not expect exact symmetry, which would also look unconvincing.

There are only small studies on how adults experience the operation. In one of 40 adults who had the operation (Schwentner and colleagues, 2006), quality of life measured with the Glasgow Benefit Inventory improved after surgery, with no differences between men and women; another, of 28 patients operated on with combined techniques (Choi and colleagues, 2017), found a sustained improvement on the questionnaire. These are retrospective studies with few patients: they tell you what happened in those groups, not what you will notice yourself.

The first otoplasty consultation

The surgeon examines your ears and listens to what you want to change. According to the ASPS, they will ask about your health, allergies, medicines and supplements, alcohol and smoking, and previous operations; they will take photographs for your medical record and talk through the options and the results that can be expected. Tell them everything, even if it does not seem important to you.

This is the time to ask which technique will be used, what anaesthesia, what the bandage is like, when it comes off and when you can return to your routine. The ASPS even has a list of questions to take to the appointment: take them written down.

How it is corrected: with or without cutting the cartilage

It is almost always done from behind, in the crease between the ear and the head, which is where the scar sits, and the cartilage is worked on from there. The ASPS explains that internal stitches, which are not removed, are used to hold the new shape. SECPRE adds that a wedge of skin is removed from the back and, sometimes, a piece of cartilage.

There are techniques that fold and fix the cartilage with stitches without cutting it, and others that weaken or trim it.

A 2020 systematic review of cartilage-sparing techniques (Ferzli and colleagues) concludes that the studies are of low quality, that these techniques appear to give better results than those that weaken the cartilage, and that methods often need to be combined for each patient. In a series of 1,060 ears (Smittenberg and colleagues, 2018), observers rated the shape and the result higher with cartilage-sparing techniques. What matters for you: there is no single technique, and the one used depends on your cartilage.

What the operation is like

At EGOS local anaesthesia is used, with sedation if the surgeon considers it necessary. The procedure takes about an hour and you go home the same day. Before the date you receive written instructions. At the end, a bandage protects the ears and holds the new position while they heal.

Otoplasty recovery: Clínica EGOS timeframes

Most patients return to their routine after about a week. The bandage put on in the operating theatre is not touched until the first dressing change, a few days later; then comes a headband, worn all day at first and, later on, only for sleeping. You can wash your hair after three to five days, you should not sleep on your side until two or three weeks have passed, and anything that could knock or bend the ears has to wait for at least a month. How long each item is worn and how to look after it is explained in the guide to the otoplasty bandage.

Otoplasty results: when they show and how long they last

For prominent ears, the ASPS says the change is visible almost immediately, when the bandage holding the new shape is removed. Then the swelling gradually goes down and the shape settles. With the ear set closer to the head, SECPRE speaks of a long-lasting result. What is achieved varies from one person to another, because each ear has its own cartilage.

What does an otoplasty quote include?

The amount for your case is set after you have been examined: the cost of otoplasty varies depending on whether one ear or both are operated on, the technique, the anaesthesia and the operating theatre. After the examination you are given the quote in writing.

Ask for it to cover fees, operating theatre, anaesthesia, bandages, headband and check-ups; and, if you are comparing centres, check that they include the same things.

Who operates and where?

The operations are carried out by registered plastic surgeons at Clínica EGOS, among them Dr Santiago Elvira i Barberà (registration no. 49756) and Dr Tiago Gomes Rodrígues (registration no. 44844). Before setting a date, ask to be told in writing who will operate on you, with their medical registration number, and at which centre.

The cities with their own otoplasty page are listed in the "Where to have otoplasty?" block further down.